Global Journeys - Student Educational Travel

On-Line Application Form for Summer Programs

Student Information

Last Name:

First Name:

Male Female

Date of Birth (DD/MM/YY):

Home Address (Number & Street):

Apt/Unit #:

City and Province/State:

Country:

Postal Code:

Home Phone:

e-mail:

Special Needs

Dietary Needs:

Do you have a medical history or use any medications of which we should be informed:

yes no

If yes please explain:

Please identify any special education needs:

Academic Information

Present School:

School Board:

School Address:

Phone #:

Counsellor/Advisor:

Course Selection

Please check first choice

Greece/Italy

Classical Civilization, Grade 12, LVV 4U

France

French Core, Grade 11, FSF 3U

French Core, Grade 12, FSF 4U

French Immersion, Grade 11, FIF 3U

French Immersion, Grade 12, FIF 4U

French, Extended, Grade 11, FEF 3U

French, Extended, Grade 12, FEF 4U

World History: The West and the World, Grade 12, CHY 4U

New Zealand/Australia

Biology, Grade 11, SBI 3U

Biology, Grade 12, SBI 4U

England/Scotland/Ireland

English, Grade 11, ENG 3U

English, Grade 12, ENG 4U

Italy

English, Grade 12, ENG 4U

English Studies in Literature, Grade 12, ETS 4U

Philosophy, Grade 12, HZT 4U

Italian, Introductory Course

Bermuda

Biology, Grade 11, SBI 3U

Biology, Grade 12, SBI 4U

The Environment and Resource Management, Grade 12, CGR 4M

Ecuador/Peru

World Issues, Grade 12, CGW 4U

The Environment and Resource Management, Grade 12, CGR 4M

South America: The Land, The People, The Impact, Biogeography, Interdisciplinary Course, IDC 4U

Experience the Arts in Amsterdam/Berlin/Florence/South of France

Experience the Arts, Grade 12, IDC 4U

The Grand Tour in London/Paris/Rome - August

Experience the Arts, Grade 12, IDC 4U

English, Grade 12, ENG 4U

Philosophy, Grade 12, HZT 4U

Please indicate second choice:

Location:

Course:

I would like to room/class with

(if applicable and possible)

Parent/Guardian Information

Mother Last Name:
First Name:

Same address as child
Home Address:
Phone#: Business#:
email: Fax:#:

Father Last Name:
First Name:

Same address as child
Home Address:
Phone#: Business#:
email: Fax:#:

Name of legal guardian if applicable:

Payment

Comprehensive Travel Insurance
(optional but strongly recommended) $195 Bermuda/Ecuador Online programs $295 All other programs

I will purchase the travel insurance:

yes

Once you submit your application, a Payment Form will be emailed to you and a staff member will contact you to confirm space and receipt of your application. A deposit of $1200 (cheque made payable to Global Journeys - STS Travel) or payment by credit card along with your $90 application fee and travel insurance fee, if applicable, will be required within 10 business days to reserve your space in the program. A letter of acceptance and further details will follow.

I would like to receive an invoice by:

Email

FAX

Post

I have read the Terms and Conditions and agree to these terms and conditions.